Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA4270 | MS |
NPI | 1003242231 |
---|---|
Provider Name | Melissa Smithhart |
First Address | Vicksburg, MS 39183-8505 |
Second Address | Vicksburg, MS 39180-5271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2013 |
Last Update Date | 19/09/2013 |